Hela PHA CEO issues call for reform

Experienced health executive officer, Dr James Kintwa has urged policy-makers to take note of the lessons he’s learning in transforming healthcare in remote Hela Province.

A former Chief Executive Officer of Mt Hagen Hospital, Dr James Kintwa was appointed to head up Hela’s Provincial Health Authority (PHA) in August 2017 following the launch of the new PHA.

Dr Kintwa and his team built on the work started by the Hela Provincial Hospital Board to address many challenges in improving service delivery. These included difficulties improving health in rural areas, a lack of funding, and problems attracting experienced staff to work in the province – for example in 2015 the Tari Hospital only had one government doctor. Improving health infrastructure was also a major challenge as was building the capacity for strong and effective governance. These challenges were leading to poor health indicators including high levels of maternal and child mortality and deaths from preventable diseases such as measles.

Following the appointment of a new board led by Oil Search Managing Director Peter Botten, significant financial and capacity support from the Oil Search Foundation and help from 15 other partners the situation has greatly improved. Government money is flowing to the districts for the first time in decades and being spent wisely and well. Aided by the 12 terrific doctors, a highly capable executive team, a focused, pro-active board and clear governance processes, the Hela PHA has pursued an ambitious and wide-ranging health agenda and achieved it on time and under budget.

Despite regular outbreaks of tribal conflict, and the catastrophic 2018 earthquake, the people of Hela have been seeing more outreach clinics than ever before with a significant increase in the number of outreach clinics in 2018, together with some significant improvements in their local health centres. Close to 100% of residents can now consider themselves immune to polio, and malaria rates remain extremely low across the province, and more people are completing TB treatment.

Hela Provincial Hospital, for its part, is functioning better than ever, and will soon nearly double in size due to long overdue investments in infrastructure. A brand-new Accident and Emergency Ward is now just six months from completion, and will soon be joined by an upgraded power supply, new doctors' houses, a new outpatients area, offices for administration staff, water tanks, a new nursing quarters and kitchen, blood bank, x-ray unit and pathology laboratory.

“The improvement in Hela’s health services has been simply incredible,” says PHA board chair Peter Botten, who, in addition to being the Managing Director of Oil Search is also a Board member of the Oil Search Foundation.

Dr Kintwa and his team have done an amazing job including in managing partnerships - getting different people to work out what goals they have in common, and then get them to work together until those goals are achieved.’

So how has Dr Kintwa and his team managed to do it? As the PNG government rolls out PHAs across the country, what big lessons can this province provide?

The first is the importance of strong governance. Dr Kintwa noted that “It not enough to have a capable chair and very well-conducted board meetings, though I am very pleased to say we have both. To properly oversee key PHA decisions, it is equally vital to establish a wide range of sub-committees that oversee good clinical and administrative governance and have them meet regularly and identify potential for improvements.

“At a board level, we also find that maintaining running sheets of our own actions can be been extremely helpful at times, and that it can also be useful to use in-camera board sessions when dealing with sensitive matters that could be a source of distraction in more formal settings.”

Lesson two, declares Dr Kintwa, is that PHAs and partners must take an active interest in government – and encourage government to take an interest in them. “Engage political leaders early and engage them often,” is his simple advice, “and if they’re from your district, then engage even more. The Hela experience shows that when political engagement is situated as part of a wider strategy it can reap significant rewards. Above all, prioritise approaches to districts. It is at this level that political, bureaucratic, and community interest tend to most closely align.”

Lesson three for PHA boards is that they should understand in detail health financing and how finances are managed. “The payment of Health Function Grants direct to PHAs was a huge reform and I hope this stays in place. It’s also definitely worth identifying all sources of your health funding at both the provincial and national level, and really taking time to carefully scrutinise precisely how they’re accessed and spent. When it comes to budgets and finance, every toea counts and must be directed and managed accountably. Investment in finance systems and capacity is essential and should not be overlooked – it is an important as doctors and nurses in ensuring improvements in health indicators’. Around 3.5 million kina was allocated by Open Members and the Provincial Governor to support health infrastructure improvements across Hela.

Dr Kintwa’s final, and perhaps most important, point was that the best-run and most successful PHAs tend to be the ones that really focus on partnerships. “Healthcare in Hela Province is above all a community enterprise. We simply wouldn’t be able to do what we do without dedicated partners like Oil Search and the Oil Search Foundation, which in recent years have contributed over K91 million. Other businesses and partners include Santos, ExxonMobil, Curtin Brothers, Bank South Pacific, the Australian Government, Asian Development Bank, WHO, and other United Nations organisations. All these partners have contributed funding and expertise, and we are deeply grateful to all of them.”

“But our partnerships certainly don’t end with the private sector and donors. In fact, that’s not even where they begin. We also enjoy tremendous support from individuals and community groups all over the province, along with the District Development Authorities and some wonderful church health services. Our Governor and Prime Minister and district members have all contributed funds. International organisations like Rotary, Susu Mamas and Marie Stope have also proved to be invaluable service delivery partners.”

Dr Kintwa singled out the churches “We are supporting Church Health Services by releasing health functional grants which provides the money needed to run each facility and deliver a basic health care package for our people according to the Minimum Priority Activities (MPA).”

“I would urge every emerging PHA board to make partnerships of this sort absolutely central to their service delivery. Identify key players in your region, be clear about they can bring, commit to common operating principles, and clearly document expectations. It is even worth establishing a sub-committee that solely dedicated to develop key relationships and building new ones wherever they can.”

“Reaching out to partners, and finding common ground, can be hard and take a great deal of time. But I can promise you all from the bottom of my heart that it is never time wasted.”

“The current state of healthcare in Hela could easily be called a success story. But above and beyond anything else, it is a story of partnership and there are many lessons to be learned for current and future

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